4. Which antiarrhythmic drug is recommended for patients who have atrial fibrillation that is vagally mediated?

A. Disopyramide

B. Quinidine

C. Amiodarone

D. Sotalol

E. Flecainide

Atrial fibrillation triggered by situations of vagal stimulation has been well described (nausea, vomiting, abdominal pain, severe coughing, young healthy athletes with high vagal tone, etc.). In this scenario, the historical antiarrhythmic drug that has been successful is disopyramide. This agent has significant anticholinergic activity, making it more effective in this situation.